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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243810158
Report Date: 08/10/2021
Date Signed: 08/10/2021 04:04:08 PM

Document Has Been Signed on 08/10/2021 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCEY SPRINGS PRESCHOOLFACILITY NUMBER:
243810158
ADMINISTRATOR:ROCHA, JENNIFERFACILITY TYPE:
850
ADDRESS:1900 S MERCEY SPRINGS RDTELEPHONE:
(209) 826-2241
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ericka BautistaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Brannon conducted an announced pre-licensing follow up inspection. LPA met with Site Supervisor, Ericka Bautista. Previous pre-licensing inspection was conducted on 7/30/21, with a list of 12 items to correct. All listed items were corrected.

Licensee installed a temporary shade structure on the outside play area. LPA allowed three months to send in documentation/invoice of new permanent shade structure. If more time is needed, licensee can send in a request to their LPA. Upon deciding upon a new permanent shade structure, licensee shall send in a copy of the manufacturing specifications, estimated completion date and an inspection by Licensing of the newly installed shade structure will be required before day care children can utilize the outside play area.

Pending a final file review, a recommendation will be made to license the above facility for a capacity of 24 preschool children.

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Cynthia Brannon
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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